Zero AHI with one weird trick? (Vitamin E)

[Russ6813]

First of all thank you for this board, it has been an incredible resource. I posted my story in the new members thread a couple weeks back

Don't mean to be click-baity with the subject line but I was stunned this morning, although it could be a onetime fluke.

If you look at my overview of ahi from August in the attachment you can see that I found this forum around Nov 1st.
That's when I learned about sleep position and started side sleeping with pillows. AHI went from sleep study numbers of 15-20 events per hour then to CPAP helped 7-14 AHI all the way down to a current average just under 2 AHI after the sleep position changes.

Currently I have an eliminator collar to keep my neck level and I use a rib belt** to wrap a large pillow around my back so I cant roll over in the night. 

Being a perfectionist I get upset when I have nights that hit 6 or 7 AHI since I like seeing the numbers between 1 and 2 AHI but either way I was happy if this was going to help me live better.  I know some others on this board have bigger challenges than I do so I'm thankful I could get my numbers down and will hopefully see my life improving going forward.

Separately I have atrial fibrillation (heart arrhythmia) which may have been caused by my sleep apnea so I started taking Vitamin E last night specifically for my heart.  

This morning woke to ZERO "0" AHI events.  No central, no clear airway, no obstructive, no hypopneas.  I thought my machine was malfunctioning but everything looks normal there was air pressure, I had leaks and three separate sleep segments.  I am attaching last nights screenshot as well as a recent regular night screenshot for comparison (nights usually vary from .75 ahi to 3.7 ahi but some are higher).  

I'm curious if anyone has seen this effect also?   I wasn't taking vitamin E for the sleep apnea just to help my heart.

This is Vitamin E I bought at Walmart - Spring Valley 180mg/400iu alpha tocopheryl acetate

I know it is just one night so will keep taking Vitamin E and see if this zero number continues.  It might have been a one time fluke I will report back in the coming weeks.

Thanks again for this board it has been a lifesaver!

Russ



**Instead of wearing a back pack to bed or sewing a tennis ball into t-shirt I chose to wrap a large pillow around me.  A rib belt is a velcro belt usually used to wrap your broken ribs.  It is 50" long so it fits around a large pillow and my torso.  It is $15 in the pharmacy section where the knee and ankle wraps are sold.  The pillow is a king size firm memory foam pillow.  Not the one piece memory foam but individual pieces of memory foam in a pillow if that makes sense.  It gets it shape back during the day unlike a down filled pillow. I have 2 of these pillows against each other (one is strapped to my torso) and it prevents me from rolling over

[Sleeprider]

Whether or not it is coincidental, your therapy has been trending in a good direction for some time, and we can see you had almost no pressure fluctuation at all. Even the night with AHI of 4.17 seems to be a function of a positional issue at 02:20 and some sleep disruption. The next step is to figure out what causes the fragmentation of sleep into 3 or more sessions. This is the only aspect of your therapy that seems to have declined compared to older data.

[Russ6813]

Thanks for your reply -Yes I agree with your analysis absolutely.  My numbers have gone down but I do wake up often during the night.

I had a few nights early on where I slept through the night but since then I wake up two or three times a night.

The sleep disruptions may be a combination of a couple things.

The first month or two I would wake up and the mask was totally off and don't know why.  It was not a fight anxiety type pull it off issue. But since then I wake up half asleep and check if the mask is on.  Secondly I wake and go to the restroom even though pre-cpap I might only wake up once a night. I'm 51/M but not worried about prostate or frequent urination issues in that sense since it wasn't a problem before.  So if I wake up and go to the restroom I often would lay down and forget to re attach the hose lol.

I don't have a problem wearing the mask and am comfortable with it on (Full Face F20 resmed airsense 10 autoset).  
But sometimes just wake up, feel the pressure or process and hear the back and forth breathing even though when that happens the pressure seems OK, - its not a fight to breathe with it. 

Side note - I have a deviated septum only diagnosed this year but some nights it is a fight to start breathing until my sinuses open up.  But also the reason for full face mask since it is part of the reason I am a mouth breather.

My Sleep specialist was interested in having me try an ASV machine since a majority of my events were central sleep apnea but since my numbers have dropped down so much he wanted to wait until my follow up in March.

I read with interest the thread on "Dr Barry Krakow's theory of apnea vs hypopnea vs flow limitation" with regards to ASV machines and people who have the right machine don't wake up and have more REM sleep. 

New member can't post the link - but it is in the recent list right now (12/22/2019)

I watched the youtube video and now will discuss ASV with my sleep specialist in March.
 
Although I didn't take the Vitamin E for apnea just heart protection, I understand that the Zero AHI last night may have been a fluke.  So if this Vitamin E was just a one off response to a "new" element that was introduced.  I will definitely consider tweaking machines and pressures. 

Because I changed insurance when I started with the machine my experience with the dme company and the whole process has been terrible.  If I need an ASV I may just try to purchase it outright, especially since my numbers have dropped low enough where health insurance may not cover now- good bad I guess.

I am very interested in sleeping through the night and getting more REM sleep as the study showed in the you tube video.

Thanks again!

Russ

[Sleeprider]

For sinus issues, I have used Flonase or its generic Fluticasone Propionate to be very helpful. I was having a weird blockage on exhale that was very disruptive. Congestion is a problem for many of us and you need to find something that is effective, and in your case that does not raise blood pressure or risk problems with A-fib.

Sounds like you have a good doctor that is willing to look at problems and find effective solutions. Being approved for ASV can be difficult with most practitioners. It does appear your CA events have dropped significantly, and considering your relatively low rate of central apnea, I think some alternatives may be using bilevel like the Aircurve 10 Vauto which can provide low levels of pressure support like the EPR you are using now, but also offers trigger sensitivity and minimum time of inspiration, can help many people overcome minor CA. Another approach that is discussed in our Wiki is Enhanced Expiratory Rebreathing Space (EERS) http://www.apneaboard.com/wiki/index.php...ace_(EERS) which not only corrects treatment emergent central apnea without disruptive adaptive pressure support, but significantly improved tidal volume and minute vent in individuals we have observed using it. While not widely known or used at this time, this innovative approach works with your natural respiratory drive by affecting PaCO2. It's worth learning about.

[Russ6813]

OK thanks for the fantastic info here, I will research this and discuss with my sleep specialist going forward!

Thanks again!

Russ

[snorybob]

For the Vitamin E I don't know. But if you have positive results after 4-5 night trial please keep us up to date.

The rib belt is a good idea if it works for you. If I sleep on my back (supine)  I have osa events. I've tried the tennis balls (too small & soft) back pack 
(too big) so I thought of something different. I'm trying to minimize on CPAP apparatus as much as I can.( too much already)         
                                                                                                                                                                                      
Amazon or Dollar Store I bought a high density yoga block (9x6x3 in.-$5.00), wide size men suspenders ($10.00). Undo the junction on the suspenders. Cut a slot at each end of the block (3 in. deep), slide suspender in slot (clips upward -same side), duct tape block edge so belt don't come out

Pros:  Very light- cheap $$$- ajustable- fabrication: 15 min.  -- not as warm as t- shirt / pillow / back pack 

Cons:  Another gadget for sleeping 

Easy to ajust the belts / you can put it cervical - lumbar - dorsal & believe me you can't sleep on your back.           
If you ajust it right you don't know it's there! 

                                             sb.

[AshSF]

On a separate note:

Spring valley vitamin E has dl-alpha tocopheryl acetate.

Try getting a supplement which has d-alpha tocopheryl acetate.

The ‘l’ makes it a poorly absorbed and potentially toxic.

[Russ6813]

Thanks on the vitamin E will get the better quality version

Russ

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Pretty cool solution with the yoga block here, I may set this up myself.  I think this magical zero night was one where I definitely did not sleep on my back

[Russ6813]

May not have been a magic Vitamin E fix based on last night.  Tried not to drink too much water before bed and when I woke up in the night I forced myself to stay in bed, breathe through the mask, and go back to sleep.  Realized from yesterdays conversation that I may have trained myself to get up too many times in the night since starting cpap.

Made a mental note of wake times, and remember waking up 30 mins after going to bed right around 12am, then again 1:30 and later 4:45.  Actually had to pick up my phone to see the time so I don't want to make that a habit either.  Gonna move a dim clock I have over to that nightstand in case I need to eyeball the time in the night.  Most of those times match an event but did not wake up for every event, attached a full nights data below.  

Definitely was not on my side a few times so my pillow setup with rib belt may need to be adjusted with the yoga block mentioned above.  Woke up with a loud mask leak somewhere close to sunrise, tightened the strap and it stopped.  I believe I was trying to sleep face down at that point.  

1.72 doesn't seem to be a high number but if I can manage even lower with sleep position or figure out the right machine -possible change to Vauto or ASV- with my next visit to the sleep specialist I'll keep tracking data.

Let me know what you see if out of the ordinary, will keep taking vitamin E, try not to get up in the night and see how the next 5-7 days look. 

Thanks,

Russ

[Sleeprider]

Those remain excellent results. CA is up slightly and not much we can or should do about it at that level. I mentioned that the Resmed Aircurve 10 Vauto has a "trigger sensitivity" setting which improves the switch from EPAP to IPAP. That setting resolved a similar CA problem for me and has been effective for most people I have suggested it to. It's not going to fix CAI in the double digits, but can clean up this.

I know you woke up a few times but by powering through the arousals and staying in bed you create a different behavior or habit. This will help your sleep hygiene in the long run and is a big step forward.